What methadone isn’t

Maine has serious drug abuse problems, accompanied by tragic deaths. However, methadone should not be at the top of the problem list, as implied in news reports.

Methadone is a potent painkiller and the single-most effective treatment for heroin and opioid addiction. As with other medications, its reckless misuse can have fatal consequences. Although any untimely death is a tragedy, deaths attributed to methadone in Maine have been misrepresented.

Consequently, opioid-addicted persons who could benefit from this medication, and their methadone treatment providers, have been stigmatized. Incriminating articles have relied on prejudiced commentary and poorly researched details, rather than medically valid evidence.

For example, citing mostly law enforcement sources, the Maine news media has published several articles suggesting a link between overdose deaths involving methadone and the area’s two methadone clinics. Few of the articles even mentioned that methadone is also widely available through prescriptions from doctors as a pain remedy.

So it came as no surprise that Maine newspapers ignored a recent government report that concluded that most deaths related to methadone did not involve methadone obtained from opioid-addiction treatment clinics; instead, they involved methadone dispensed or diverted from pharmacies.

Entitled Methadone-Associated Mortality: Results from a National Assessment, the report expressed the consensus of 70 experts from federal, state, and local organizations (including participants from Maine) convened by the U.S. Center for Substance Abuse Treatment and sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The group unanimously agreed that federal regulations permitting more flexibility in methadone dosing and greater allowances for take-home doses are not responsible for the increases in methadone-associated deaths. The experts observed that the increasing numbers of prescriptions written by physicians for methadone, along with associated deaths due to misuse of the drug, paralleled those statistics for other opioids – such as, oxycodone, hydrocodone, and morphine. In fact, the report noted, Maine ranks among the highest in the nation (per capita) for methadone analgesia prescriptions by physicians while take-home methadone from addiction clinics has increased very little.

In Maine, as elsewhere, methadone-related deaths most often involve multiple illicit drugs, alcohol, and/or other medications. Many victims had underlying physical or mental conditions that possibly contributed.

So, while the drug problems and deaths in Maine were noteworthy, and appeared to be growing, the data were clear that methadone was only part of a much larger problem and possibly not the gravest concern. Nevertheless, one newspaper in Maine continues to editorialize in favor of allowing doctors and hospitals to dispense methadone to opioid addicts; a “solution” that, under current law, is not an option and one that, given the current evidence, could make the diversion problem even worse.

The defendant, a patient at a methadone-treatment clinic, claimed he was prescribed too much methadone and then was allowed to take the medication home for unsupervised consumption. Therefore, he had plenty of excess methadone to give to a friend, who subsequently died of an overdose.

The judge agreed with the defendant that the prescription was excessive – an opinion supported by a non-medical and misinformed definition for how much methadone is necessary to treat addiction.

The medical facts are that a truly adequate methadone dose can range from a dozen milligrams to hundreds each day, depending on many patient factors. Having lawyers and judges make critical medical decisions, without any basis in science, is hazardous.

Another issue raised by this case was the alleged dangers of take-home methadone. There are strict federal regulations governing allowances for take-home doses, which are permitted only for patients who have demonstrated an ability to handle the drug safely. There was no evidence that the defendant in this case failed to meet those requirements.

Can methadone clinic staff be fooled by a deceitful patient who ends up misusing the drug? Yes, but rarely. And it would be unfair to allow the mischief of a few to deny take-home privileges to thousands of recovering patients who as a result can live more normal lives as productive citizens.

A persistent focus on purported evils of methadone only diverts attention from much larger questions concerning drug abuse facing the community. Open discussions of these questions should be informed by facts and medical evidence rather than biased opinions and misinformation that pander to fear and prejudice. Hopefully, public officials and the news media will take the time to become better educated so they can present a more fairly balanced dialogue on methadone to the public.

Stewart B. Leavitt, Ph.D. is an independent medical researcher, writer, and educator based in Glenview, Ill. Although he has served diverse healthcare clients during the past 25 years, addiction medicine has been a primary area of specialization.